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Van Der Donckt J, Vandenbussche N, Van Der Donckt J, Chen S, Stojchevska M, De Brouwer M, Steenwinckel B, Paemeleire K, Ongenae F, Van Hoecke S. Mitigating data quality challenges in ambulatory wrist-worn wearable monitoring through analytical and practical approaches. Sci Rep 2024; 14:17545. [PMID: 39079945 PMCID: PMC11289092 DOI: 10.1038/s41598-024-67767-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
Chronic disease management and follow-up are vital for realizing sustained patient well-being and optimal health outcomes. Recent advancements in wearable technologies, particularly wrist-worn devices, offer promising solutions for longitudinal patient monitoring, replacing subjective, intermittent self-reporting with objective, continuous monitoring. However, collecting and analyzing data from wearables presents several challenges, such as data entry errors, non-wear periods, missing data, and wearable artifacts. In this work, we explore these data analysis challenges using two real-world datasets (mBrain21 and ETRI lifelog2020). We introduce practical countermeasures, including participant compliance visualizations, interaction-triggered questionnaires to assess personal bias, and an optimized pipeline for detecting non-wear periods. Additionally, we propose a visualization-oriented approach to validate processing pipelines using scalable tools such as tsflex and Plotly-Resampler. Lastly, we present a bootstrapping methodology to evaluate the variability of wearable-derived features in the presence of partially missing data segments. Prioritizing transparency and reproducibility, we provide open access to our detailed code examples, facilitating adaptation in future wearable research. In conclusion, our contributions provide actionable approaches for improving wearable data collection and analysis.
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Affiliation(s)
- Jonas Van Der Donckt
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium.
| | - Nicolas Vandenbussche
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Stephanie Chen
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Marija Stojchevska
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Mathias De Brouwer
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Bram Steenwinckel
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Femke Ongenae
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Sofie Van Hoecke
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
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Lamunion SR, Brychta RJ, Saint-Maurice PF, Matthews CE, Chen KY. Does Wrist-Worn Accelerometer Wear Compliance Wane over a Free-Living Assessment Period? An NHANES Analysis. Med Sci Sports Exerc 2024; 56:209-220. [PMID: 37703285 PMCID: PMC10872893 DOI: 10.1249/mss.0000000000003301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
PURPOSE Accelerometers are used to objectively measure physical behaviors in free-living environments, typically for seven consecutive days or more. We examined whether participants experience "wear fatigue," a decline in wear time day over day, during typical assessment period acquired in a nationally representative sample of 6- to 80-yr-olds in the United States. METHODS Participants were instructed to wear an ActiGraph GT3X+ on their nondominant wrist continuously for seven consecutive days. Participants with seven complete days of recorded data, regardless of wear status, were included in the analyses ( N = 13,649). Wear was scored with the sleep, wake, and nonwear algorithm. RESULTS Participants averaged 1248 ± 3.6 min·d -1 (mean ± SE) of wear over the assessment, but wear time linearly decreased from day 1 (1295 ± 3.2 min) to day 7 (1170 ± 5.3 min), resulting in a wear fatigue of -18.1 ± 0.7 min·d -1 ( β ± SE). Wear fatigue did not differ by sex but varied by age-group-highest in adolescents (-26.8 ± 2.4 min·d -1 ) and lowest in older adults (-9.3 ± 0.9 min·d -1 ). Wear was lower in evening (1800-2359 h) and early morning (0000-0559 h) compared with the middle of the day and on weekend days compared with weekdays. We verified similar wear fatigue (-23.5 ± 0.7 min·d -1 ) in a separate sample ( N = 14,631) with hip-worn devices and different wear scoring. Applying minimum wear criteria of ≥10 h·d -1 for ≥4 d reduced wear fatigue to -5.3 and -18.7 min·d -1 for the wrist and hip, respectively. CONCLUSIONS Patterns of wear suggest noncompliance may disproportionately affect estimates of sleep and sedentary behavior, particularly for adolescents. Further study is needed to determine the effect of wear fatigue on longer assessments.
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Affiliation(s)
- Samuel R Lamunion
- Energy Metabolism Section, National Institute of Diabetes, Digestive and Kidney Diseases, Diabetes, Endocrinology, and Obesity Branch, National Institutes of Health (NIH), Bethesda, MD
| | - Robert J Brychta
- Energy Metabolism Section, National Institute of Diabetes, Digestive and Kidney Diseases, Diabetes, Endocrinology, and Obesity Branch, National Institutes of Health (NIH), Bethesda, MD
| | - Pedro F Saint-Maurice
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Charles E Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Kong Y Chen
- Energy Metabolism Section, National Institute of Diabetes, Digestive and Kidney Diseases, Diabetes, Endocrinology, and Obesity Branch, National Institutes of Health (NIH), Bethesda, MD
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Thomson S, Cornish BF, Pun A, McIlroy WE, Van Ooteghem K. Advances in mobility aid use reporting: situational context and objective measurement improve understanding of daily aid use in older adults. Aging Clin Exp Res 2023; 35:2543-2553. [PMID: 37907663 DOI: 10.1007/s40520-023-02533-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/08/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Understanding mobility aid use has implications for falls risk reduction and aid prescription. However, aid use in daily life is understudied and more complex than revealed by commonly used yes/no self-reporting. AIMS To advance approaches for evaluating mobility aid use among older adults using a situational (context-driven) questionnaire and wearable sensors. METHODS Data from two cross-sectional observational studies of older adults were used: (1) 190 participants (86 ± 5 years) completed tests of standing, sit-to-stand, walking, grip strength, and self-reported fear of falling and (2) 20 participants (90 ± 4 years) wore two body-worn and one aid-mounted sensors continuously for seven days to objectively quantify aid use during walking. Situational and traditional binary reporting stratified participants into aid dependency levels (0-4) and aid-user groups, respectively. Physical performance and fear of falling were compared between aid users, and dependency levels and sensor-derived walking behaviors were compared to reported aid use. RESULTS Physical performance and fear of falling differed between aid-user groups (P < 0.05). Sensor-derived outputs revealed differences in walking behaviors and aid use when categorized by dependency level and walking bout length (P < 0.05). Walking bout frequency (rho(18) = - 0.47, P = 0.038) and aid use time (rho(13) = .72, P = 0.002) were associated with dependency level. DISCUSSION Comparisons of situational aid dependency revealed heterogeneity between aid users suggesting binary aid use reporting fails to identify individual differences in walking and aid use behaviors. CONCLUSIONS Enhanced subjective aid use reporting and objective measurements of walking and aid use may improve aid prescription and inform intervention to support safe and effective mobility in older adults.
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Affiliation(s)
- Sherri Thomson
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
| | - Benjamin F Cornish
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Anthony Pun
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - William E McIlroy
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Karen Van Ooteghem
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
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Weber KS, Godkin FE, Cornish BF, McIlroy WE, Van Ooteghem K. Wrist Accelerometer Estimates of Physical Activity Intensity During Walking in Older Adults and People Living With Complex Health Conditions: Retrospective Observational Data Analysis Study. JMIR Form Res 2023; 7:e41685. [PMID: 36920452 PMCID: PMC10131658 DOI: 10.2196/41685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Accurate measurement of daily physical activity (PA) is important as PA is linked to health outcomes in older adults and people living with complex health conditions. Wrist-worn accelerometers are widely used to estimate PA intensity, including walking, which composes much of daily PA. However, there is concern that wrist-derived PA data in these cohorts is unreliable due to slow gait speed, mobility aid use, disease-related symptoms that impact arm movement, and transient activities of daily living. Despite the potential for error in wrist-derived PA intensity estimates, their use has become ubiquitous in research and clinical application. OBJECTIVE The goals of this work were to (1) determine the accuracy of wrist-based estimates of PA intensity during known walking periods in older adults and people living with cerebrovascular disease (CVD) or neurodegenerative disease (NDD) and (2) explore factors that influence wrist-derived intensity estimates. METHODS A total of 35 older adults (n=23 with CVD or NDD) wore an accelerometer on the dominant wrist and ankle for 7 to 10 days of continuous monitoring. Stepping was detected using the ankle accelerometer. Analyses were restricted to gait bouts ≥60 seconds long with a cadence ≥80 steps per minute (LONG walks) to identify periods of purposeful, continuous walking likely to reflect moderate-intensity activity. Wrist accelerometer data were analyzed within LONG walks using 15-second epochs, and published intensity thresholds were applied to classify epochs as sedentary, light, or moderate-to-vigorous physical activity (MVPA). Participants were stratified into quartiles based on the percent of walking epochs classified as sedentary, and the data were examined for differences in behavioral or demographic traits between the top and bottom quartiles. A case series was performed to illustrate factors and behaviors that can affect wrist-derived intensity estimates during walking. RESULTS Participants averaged 107.7 (SD 55.8) LONG walks with a median cadence of 107.3 (SD 10.8) steps per minute. Across participants, wrist-derived intensity classification was 22.9% (SD 15.8) sedentary, 27.7% (SD 14.6) light, and 49.3% (SD 25.5) MVPA during LONG walks. All participants measured a statistically lower proportion of wrist-derived activity during LONG walks than expected (all P<.001), and 80% (n=28) of participants had at least 20 minutes of LONG walking time misclassified as sedentary based on wrist-derived intensity estimates. Participants in the highest quartile of wrist-derived sedentary classification during LONG walks were significantly older (t16=4.24, P<.001) and had more variable wrist movement (t16=2.13, P=.049) compared to those in the lowest quartile. CONCLUSIONS The current best practice wrist accelerometer method is prone to misclassifying activity intensity during walking in older adults and people living with complex health conditions. A multidevice approach may be warranted to advance methods for accurately assessing PA in these groups.
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Affiliation(s)
- Kyle S Weber
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - F Elizabeth Godkin
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Benjamin F Cornish
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - William E McIlroy
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Karen Van Ooteghem
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
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5
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Skovgaard EL, Roswall MA, Pedersen NH, Larsen KT, Grøntved A, Brønd JC. Generalizability and performance of methods to detect non-wear with free-living accelerometer recordings. Sci Rep 2023; 13:2496. [PMID: 36782015 PMCID: PMC9925815 DOI: 10.1038/s41598-023-29666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Wearable physical activity sensors are widely used in research and practice as they provide objective measures of human behavior at a low cost. An important challenge for accurate assessment of physical activity behavior in free-living is the detection non-wear. Traditionally, heuristic algorithms that rely on specific interval lengths have been employed to detect non-wear time; however, machine learned models are emerging. We explore the potential of detecting non-wear using decision trees that combine raw acceleration and skin temperature, and we investigate the generalizability of our models, traditional heuristic algorithms, and recently developed machine learned models by external validation. The Decision tree models were trained using one week of data from thigh- and hip-worn accelerometers from 64 children. External validation was performed using data from wrist-worn accelerometers of 42 adolescents. For non-wear episodes longer than 60 min, the heuristic algorithms performed the best with F1-scores above 0.96. However, regarding episodes shorter than 60 min, the best performing method was the decision tree model including the six most important predictors with F1 scores above 0.74 for all sensor locations. We conclude that for classifying non-wear time, researchers should carefully select an appropriate method and we encourage the use of external validation when reporting on machine learned non-wear models.
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Affiliation(s)
- Esben Lykke Skovgaard
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, 5230, Odense, Denmark.
| | - Malthe Andreas Roswall
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, 5230, Odense, Denmark
| | - Natascha Holbæk Pedersen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, 5230, Odense, Denmark
| | - Kristian Traberg Larsen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, 5230, Odense, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, 5230, Odense, Denmark
| | - Jan Christian Brønd
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, 5230, Odense, Denmark
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Beswick E, Fawcett T, Hassan Z, Forbes D, Dakin R, Newton J, Abrahams S, Carson A, Chandran S, Perry D, Pal S. A systematic review of digital technology to evaluate motor function and disease progression in motor neuron disease. J Neurol 2022; 269:6254-6268. [PMID: 35945397 PMCID: PMC9363141 DOI: 10.1007/s00415-022-11312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common subtype of motor neuron disease (MND). The current gold-standard measure of progression is the ALS Functional Rating Scale-Revised (ALS-FRS(R)), a clinician-administered questionnaire providing a composite score on physical functioning. Technology offers a potential alternative for assessing motor progression in both a clinical and research capacity that is more sensitive to detecting smaller changes in function. We reviewed studies evaluating the utility and suitability of these devices to evaluate motor function and disease progression in people with MND (pwMND). We systematically searched Google Scholar, PubMed and EMBASE applying no language or date restrictions. We extracted information on devices used and additional assessments undertaken. Twenty studies, involving 1275 (median 28 and ranging 6-584) pwMND, were included. Sensor type included accelerometers (n = 9), activity monitors (n = 4), smartphone apps (n = 4), gait (n = 3), kinetic sensors (n = 3), electrical impedance myography (n = 1) and dynamometers (n = 2). Seventeen (85%) of studies used the ALS-FRS(R) to evaluate concurrent validity. Participant feedback on device utility was generally positive, where evaluated in 25% of studies. All studies showed initial feasibility, warranting larger longitudinal studies to compare device sensitivity and validity beyond ALS-FRS(R). Risk of bias in the included studies was high, with a large amount of information to determine study quality unclear. Measurement of motor pathology and progression using technology is an emerging, and promising, area of MND research. Further well-powered longitudinal validation studies are needed.
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Affiliation(s)
- Emily Beswick
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Thomas Fawcett
- The School of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Zack Hassan
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Deborah Forbes
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Rachel Dakin
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Judith Newton
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Sharon Abrahams
- Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK.,Human Cognitive Neurosciences, Psychology, School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK.,UK Dementia Research Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - David Perry
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK
| | - Suvankar Pal
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK. .,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK. .,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK.
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